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Case Based Discussion (CBD)

The CBD was originally developed for the foundation training period and was contextualised to the surgical environment. The method is designed to assess clinical judgement, decision-making and the application of medical knowledge in relation to patient care in cases for which the trainee has been directly responsible. The method is particularly designed to test higher order thinking and synthesis as it allows assessors to explore deeper understanding of how trainees compile, prioritise and apply knowledge. The CBD is not focused on the trainee's ability to make a diagnosis nor is it a viva-style assessment. The CBD should be linked to the trainee’s reflective practice.

The CBD process is a structured, in-depth discussion between the trainee and the trainee’s assessor (normally the Assigned Educational Supervisor) about how a clinical case was managed by the trainee, talking through what occurred, considerations and reasons for actions. By using clinical cases that offer a challenge to the trainee, rather than routine cases, the trainee is able to explain the complexities involved and the reasoning behind choices he or she made. It also enables the discussion of the ethical and legal framework of practice. It uses patient records as the basis for dialogue, for systematic assessment and structured feedback. As the actual record is the focus for the discussion, the assessor can also evaluate the quality of record keeping and the presentation of cases.

Most assessments take no longer than 15-20 minutes. After completing the discussion and filling in the assessment form, the assessor should provide immediate feedback to the trainee. Feedback would normally take about 5 minutes.

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